Yamamoto Masaaki, Serizawa Toru, Sato Yasunori, Higuchi Yoshinori, Kasuya Hidetoshi, Barfod Bierta E
Katsuta Hospital Mito GammaHouse, Hitachi-naka, Japan; Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
Tokyo Gamma Unit Center, Tsukiji Neurological Clinic, 1-9-9 Tsukiji, Chuo-ku, Tokyo, Japan.
Lung Cancer. 2020 Nov;149:103-112. doi: 10.1016/j.lungcan.2020.07.037. Epub 2020 Aug 18.
There is little information on stereotactic radiosurgery (SRS) results for brain metastases (BMs) in lung cancer patients ≥75 years of age. We aimed to reappraise whether SRS results for patients ≥75 (very elderly) differ from those of patients with 65-74 years old (elderly).
This IRB-approved retrospective cohort study was based on our prospectively-accumulated database including 7351 consecutive patients undergoing gamma knife (GK) SRS performed for BMs by two highly experienced neurosurgeons during the 1998-2018 period. We selected a total of 2915 elderly patients (age ≥65 years, 39.7 % of the 7351) with lung cancers (902 females, 2013 males, median age; 72 [maximum; 96] years, 2441 NSCLCs, 474 SCLCs) for this study.
Post-SRS median survival times (MSTs, months) differed significantly between the two lung cancer types, NSCLC (9.0) and SCLC (7.2, p < 0.0001). In NSCLC patients, post-SRS MSTs were significantly shorter in the very elderly (9.7) than those in the elderly (7.8) group (p < 0.0001). However, in SCLC patients, there were no significant MST differences (7.3 vs 6.9, p = 0.52) between the two age groups. In both NSCLC and SCLC patients, neither crude nor cumulative incidences of secondary endpoints in the very elderly group, i.e., neurological death, neurological deterioration, local recurrence, repeat SRS, salvage whole brain radiotherapy and SRS-related complications, were shown to be unfavorable to those in the elderly group.
Our results suggest that carefully-selected patients ≥75 years of age are not poor candidates for SRS as compared to those 65-74 years old.
关于75岁及以上肺癌患者脑转移瘤（BMs）的立体定向放射外科治疗（SRS）结果的信息很少。我们旨在重新评估75岁及以上（非常老年）患者的SRS结果是否与65 - 74岁（老年）患者不同。
这项经机构审查委员会（IRB）批准的回顾性队列研究基于我们前瞻性积累的数据库，该数据库包括1998 - 2018年期间由两位经验丰富的神经外科医生为脑转移瘤进行伽玛刀（GK）SRS治疗的7351例连续患者。我们总共选择了2915例老年肺癌患者（年龄≥65岁，占7351例的39.7%）进行本研究，其中包括902例女性、2013例男性，中位年龄为72岁（最大年龄96岁），其中2441例为非小细胞肺癌（NSCLC），474例为小细胞肺癌（SCLC）。
SRS术后中位生存时间（MST，月）在两种肺癌类型之间存在显著差异，NSCLC为9.0个月，SCLC为7.2个月（p < 0.0001）。在NSCLC患者中，非常老年组（9.7个月）的SRS术后MST显著短于老年组（7.8个月）（p < 0.0001）。然而，在SCLC患者中，两个年龄组之间的MST没有显著差异（7.3个月对6.9个月，p = 0.52）。在NSCLC和SCLC患者中，非常老年组的次要终点（即神经学死亡、神经学恶化、局部复发、重复SRS、挽救性全脑放疗和SRS相关并发症）的粗发病率和累积发病率均未显示比老年组更差。
我们的结果表明，与65 - 74岁的患者相比，经过精心挑选的75岁及以上患者并非SRS的不佳候选者。
